For those of you who live North of the equator and are entering a season of hot and humid weather and increased outdoor activity,
please be aware that extra loss of salt (through sweat) and extra burning of calories can trigger a rising BP, and other pre-eclampsia
symptoms. Please see the "Special Needs" page and the bottom of the "Weekly Record" page for ideas on how to compensate for
these losses and thus help yourself to prevent pre-eclampsia and other complications related to low blood volume. Please
see the "FAQ" page for information about why just drinking extra water probably won't be enough to keep your blood volume
adequately expanded for an optimally healthy pregnancy.

For those of you who live South of the equator and are entering the cold winter season, please be aware that many homes and
work environments are over-heated (with very dry air) and may cause you to lose salt and fluids in the same way as hot weather
does. And shoveling snow or working out in a gym burns extra calories. These losses might also lead to a falling blood volume,
and its accompanying complications, just as the summer heat and activity can. So please be watchful and care for your personally
unique needs for salt and fluids, as well as your unique needs for calories and protein.

There is a summary and list of suggestions at the end of this page, before the list of charts

"Intra-uterine growth retardation" is the term used when the baby is not growing as much as it should be. Babies who are
smaller than they should be at this stage of the pregnancy are called "small for gestational age" (SGA).

If you are going to a midwife, she has been measuring your belly every visit, from your pubic bone to the top of your uterus
(the top is called the "fundus"). The measurement is taken in centimeters (cm), and the number of cm of your measurement
should equal the number of weeks of pregnancy (gestation) that your baby is, plus or minus 1-2 cm.

When a baby is smaller than s/he should be for her/his gestational age, one of the first things that a midwife should look
for is whether you have been eating enough of the right kinds of foods, because the only way the baby can grow is by taking
in nutrients that come to her/him through the umbilical cord, and those nutrients can only come from foods that you eat.
Contrary to the beliefs of some, the baby cannot create the nutrients that s/he needs from the mother's body fat.

At the first sign of a rising BP, pathological edema, pre-eclampsia, IUGR, premature labor, or HELLP, a Brewer Diet counselor
should sit down with the mother and help her to evaluate her lifestyle and her diet to see if any adjustments can be made
to optimize the fit between her pregnancy, her diet, and her lifestyle. For example, to compensate for her salt and calorie
losses, she can cut back on her exercise program and her work schedule, she can stay out of the heat (outdoors, at work, or
at home), she can postpone a move until after the birth (and 6 weeks postpartum), and she can increase her salt/calorie/protein
intake. One way that she can increase her diet intake is to add 200 calories and 20 grams of protein for each of the following
situations:

Vomiting past the third month of pregnancy.

Pregnancies spaced less than a year apart.

Previous pregnancy with low birthweight, neurologically handicapped, or stillborn child as the outcome.

The above information is reprinted and adapted from the work of Agnes Higgins, and Gail Brewer's "The Complete Pregnancy
Diet: Meeting Your Special Needs" from Eating for Two, by Isaac Cronin and Gail Sforza Brewer, 1983.

Please be aware that traveling and moving can break up your eating routine just enough to trigger a low blood volume problem
which can start the rising BP/pre-eclampsia/HELLP/premature labor/IUGR/abruption process. Putting the brakes on that process
can be more difficult than preventing it. Sometimes just being aware of this danger is enough to help you to remind yourself
to continue providing for your nutritional needs, in spite of any changes and stresses which may be going on in your life.

Five Minute Lesson in Preventive Obstetrics
Tom Brewer, MD
12-12-1980

There are two central facts which need emphasis:

1. The human placenta creates an ARTERIO-VENOUS SHUNT (A/V) in the maternal circulation. During the last trimester of normal
pregnancy, 50 to 60 jets of arterial maternal blood spurt up against the fetal cotyledons with each maternal cardiac systole.
This blood swirls about in the intervillous space and passes via "tub drains" back into the uterine venous system.

2. The A/V shunt requires for optimal fetal growth and development an INCREASING MATERNAL BLOOD VOLUME throughout the second
trimester to a plateau which must be maintained throughout the entire third trimester.

Failure to recognize these two well-established facts has created havoc in human maternal-fetal health throughout the whole
western world, especially in the USA, Canada, and the United Kingdom. The observed reduction in utero-placental blood flow
associated with common human reproductive pathology has not been correctly interpreted as the result of hypovolemia, failure
to maintain a physiological expansion of maternal blood volume.

Physicians commonly carry out dietary restrictions of calories and sodium and give drugs, diuretics, sodium substitutes, anorexiants,
vasodilators etc. which actually cause and/or enhance maternal hypovolemia. Intrauterine fetal growth retardation (IUGR)
and small for gestational age (SGA) babies have increased dramatically since the 1950s, especially in these three nations,
where the role of prenatal malnutrition in causing human reproductive casualty in still universally denied by medical authorities.
Applied physiology and basic nutrition science in human prenatal care as a routine for all women all through gestation much
form the basis of true, primary prevention in this field.

The following questions and answers regarding IUGR are from The Brewer Medical Diet for Normal and High-Risk Pregnancy,
by Gail Sforza Brewer (Krebs) and Tom Brewer, MD.

But if I salt my food to taste for nine months, won't that cause a lot of swelling from excess water retention?
Many women cut out all added salt during the last few days of their menstrual cycles, anyway, because it helps get rid of
that bloated feeling. Aside from the discomfort, isn't swelling a danger sign in pregnancy? (p. 48)

Note from Joy: See paragraph #6 for explanation of IUGR.

It certainly can be a danger sign--but only when the swelling is caused by not eating enough of the right foods (including
sodium-rich ones) or by a medical condition that would cause swelling in a non-pregnant woman or a man as well, such as heart
failure or kidney disease.

The swelling that accompanies the normal course of pregnancy while you are on the Brewer Medical Diet is attributable to an
entirely different cause--your healthy, well-functioning placenta. The same hormones that you've noticed make you swell up
somewhat just before your period (some women hold an extra 5 to 7 pounds of water) are made in ever-increasing amounts by
your placenta as pregnancy goes along. By the eighth month, in the well-nourished mother, the placenta makes--every day--the
equivalent of the hormones in a hundred birth control pills! This swelling is not hazardous to you or to your baby. In fact,
it's a natural way for your body to prepare for labor and breastfeeding by storing fluids you may need to avoid dehydration
if your labor lasts a long time and to establish and maintain quality milk production.

Though all swelling may look the same, the situation inside your body is critically different when you are swelling
on a good diet. On a nutritionally sound diet your liver has all the building blocks it needs to manufacture adquate amounts
of a protein, albumin, that holds water in your circulation--the primary means by which your increased blood volume needs
are met during pregnancy. The larger volume of nutrient-rich blood servicing your placenta results in the larger production
of female hormones and, so, more water retention than in a mother with average nutrition. It is possible for your tissues
to hold 10 to 15 pounds of fluid for this reason without causing much change in your appearance--perhaps the fine lines in
your face disappear and your rings feel somewhat tighter.

This "hidden" water retention in the well-fed pregnant woman (plus the increased size of her baby) has seldom been accounted
for in the charts that break down the components of average weight gain in pregnancy, so they typically show a total of 24
to 28 pounds, whereas women on the Brewer Medical Diet gain, on the average, 35 to 45 pounds. Of course, many women gain
less and many gain more based on their prepregnancy weights, metabolism, and activity level. We do not use the average as
a rule (either a floor or a ceiling) for weight adjustment in pregnancy; it only demonstrates that the average figure you
see elsewhere fails to consider the additional, beneficial water retention that comes with a good diet.

When your diet is not meeting your nutritional needs, the internal events are exactly the opposite. If the liver is
undersupplied with the nutrients needed to produce albumin (and this is one of the most complicated functions the liver performs,
so it's one of the first to go when nutrients are scarce), it cuts back. This decrease in production is detectable by analyzing
a sample of blood: anything below 3 grams per 100 cubic centimeters of serum indicates a problem. With less albumin circulating
and drawing water into the circulation, water that should be held inside your blood vessels cannot stay there. Instead, it
leaks out into your tissues. Voila! You're swelling up, and the scales tell you about the water you're retaining--but
they don't tell you where it is. Nor do they tell you that your blood volume is falling below the needs of a healthy pregnancy
and that your placenta is starting to malfunction because of the reduced amount of blood flowing through it.

The pregnant woman on a poor diet (or even one on a basically nutritious diet who is not eating enough to meet her calorie
needs) is not swelling from the influence of an increase in female hormones generated by a generous, healthy placenta. She
is experiencing a shift of essential body fluids out of her circulation and into her tissues. If the situation continues,
her other critical body organs, like the kidneys, liver, heart, lungs, and brain, become adversely affected by the dwindling
blood supply (the kidneys respond, for example, by raising the blood pressure), and her baby begins to suffer intrauterine
malnutrition. Most commonly this situation is diagnosed after a few weeks when the baby's failure to grow is noted at subsequent
prenatal appointments. The medical terminology for this condition is intrauterine growth retardation (IUGR). If caught early
enough, the situation can be reversed with appropriate nutritional intervention--by getting the mother on a diet suitable
for her pregnancy needs and keeping her on it for the rest of her pregnancy. This includes salting to taste.

This interconnection between the foods you eat, how your liver works to keep your blood volume expanded, and the transfer
of nutrients to your baby via the placenta is central to every successful pregnancy. It is impossible for anyone to evaluate
what's happening internally from looking at your swelling or pressing your shinbone to see if you have water retention. Laboratory
work measuring your blood proteins and hematocrit reading must be done before any diagnosis is made.

Swelling on a good diet is a sign of health in pregnancy. So salt to taste as an integral part of your pregnancy nutrition
program. Do not restrict salt. Do not take diuretics or appetite suppressants to control your weight. Any of these actions
is a direct attack on the expansion of your blood volume and places you and your baby in jeopardy for the most serious pregnancy
complications.

Note from Joy: While the use of amphetamines and diuretics may no longer be considered the mainstream treatment
of choice for the symptoms of toxemia, other methods of weight control in pregnancy and treatments for toxemia are currently
in vogue which are equally hazardous to both the baby and the mother. And unfortunately, the hazards of these current treatments
are no more recognized by the mainstream practitioners of today than were the hazards of the earlier use of amphetamines and
diuretics by the practitioners of yesterday. I have been witness to some of the current hazardous treatments, just within
the past 5-10 years.

I worked for a homebirth midwifery practice for several years. For most of that time, all the midwives were supportive of
the use of the Brewer Diet by the clients of the practice. The last year of my time there, we got a new midwife on staff
who was very opposed to the use of the Brewer Diet. Whenever we got a new client who was the least little bit on the plump
side, she would apparently tell her to get a little more exercise and eat a little less carbohydrates. When her blood pressure
would start to creep up, she would tell her to cut back on her salt a little bit. No amount of my trying to explain the Brewer
insights to her made any headway. As a result, within the first six months of her being on staff, we had 2-3 clients who
had to be hospitalized with blood pressure problems and premature labor, as I recall, which was very uncharacteristic of our
practice.

So it is very important that we not dismiss the historical accounts that Brewer has documented for us. We need not look down
our noses at his reports of the starvation-amphetamine-diuretic practices of the physicians around him in his early days,
and his efforts to stop those practices. We have our own faulty treatments in our own time, which are based on the same faulty
thinking, and are just as hazardous as the treatments that he witnessed.

In addition, unfortunately, some areas of the "alternative medicine" community have apparently followed mainstream medicine
in the belief that diuretics are important and useful for treating edema and elevated blood pressure in pregnancy. Many pregnancy
teas and some supplements and juices include nettle, dandelion, alfalfa, bilberry, or celery, all of which have diuretic properties.
Diuretics are no safer for pregnancy in herbal form than they are in prescription medications, so it is important for pregnant
women to watch which herbs they are taking.

I had ultrasound scans at twenty-four and twenty-eight weeks because my family doctor was having trouble deciding whether
my baby was growing normally.

There didn't seem to be much change in the size of my uterus from twenty weeks to twenty-four weeks. The scan done
at twenty-eight weeks shows that my baby is only the size of a twenty-three week pregnancy. My doctor wants me to travel
a hundred miles to a high-risk pregnancy unit at our state medical school hospital and be admitted for tests. I just found
out about your diet and I know I haven't been eating anywhere near that amount of food. If I start eating better now, will
my baby catch up, or is it too late?

You still have the last twelve weeks of pregnancy to go--the time when your baby puts on weight most rapidly--so yes, catching
up is possible, assuming you haven't been severely limiting your food intake up until now. In some cases where the growth
of the placenta has been impaired because of very poor diet, the recovery period for the baby is not so successful--no matter
how well you eat toward the end of your pregnancy. There is less placental mass and a reduced capacity to transfer the nutrients
you are suddenly providing from the foods that you eat.

We are always optimistic about efforts to improve the feeding of pregnant women, though, based on the work of Leela Iyengar,
M.D., of India published in this country in 1968. She brought women diagnosed as malnourished into the hospital and fed them
over the last four weeks of pregnancy. The birth weights of babies born to these mothers were a full pound more, on the average,
than those of babies whose mothers were also identified as malnourished but were not provided supplemental feeding. Placental
function, measured by excretion of estrogens in the urine, also improved dramatically following the improvement of the mothers'
nutritional status.

So don't despair. Chances are good that you can do a great deal for your baby during these next three months, especially
since this is the critical period of time for the development of your baby's brain. It used to be thought that everything
of significance in organ formation happened in the first three months of gestation, but much work now points to the last eight
to ten weeks of pregnancy as another time when even mild degrees of maternal undernutrition can prevent the brain from developing
normally.

There are some nonnutritional causes for intrauterine growth retardation that your doctor probably would like to rule out
as being of signigicance in your case (hence, the tests in the regional high-risk center). Infections your baby may have
acquired in utero, abnormalities of the placenta and/or cord, and abnormalities of the baby's chromosomes or heart can also
cause your baby to be small for gestational age (SGA). However, before you enter the hospital for the series of tests, give
improved nutrition a try for two or three weeks and then ask for a reappraisal of your situation. Explain to the doctor that
you don't think you've been eating well enough and you'd like to see if a trial of improved nutrition will bring about increased
growth. Since there is nothing to be done for the nonnutritional causes for SGA babies, you have nothing to lose by waiting.

The series of tests at the high-risk unit would probably also include an evaluation of your kidneys, cardiovascular system,
any nonnutritional anemias, and the presence of any other medical diseases that might require treatment. You will also be
asked about your smoking, drinking, and hard drug habits, all of which can be associated with a slower rate of fetal growth
primarily because they substitute for eating.

There is one last factor to be considered. Are you sure of when you conceived? If you became pregnant while breastfeeding
and hadn't truly resumed normal periods, or if you became pregnant immediately after stopping birth control pills, you may
not be as far along as your chart says. In either case, all you can do now is to start eating correctly every day to see
if you can bring your baby at least up to appropriate weight for weeks of gestation.

A repeat scan will detect any failure of your baby to grow (intrauterine growth retardation, or IUGR). However, measuring
the height of your uterus, a time-honored way of appraising fetal growth, can also sound the alert. Any time it is suspected,
of course, the treatment for IUGR must include a complete nutritional workup and correction of any deficiencies. All too
often, the mother is just assigned to a high-risk category, shifted to the care of a high-risk specialist until her underweight
and sickly infant is born, and her nutrition fades into the background as a battery of tests are ordered many times over.

Agnes Higgins, past president of the Canadian Dietetic Society and director of the Montreal Diet Dispensary [as of 1983],
has developed a procedure for estimating calorie and protein requirements in excess of the pregnancy levels we've already
established as a baseline. She emphasizes that any of the following factors increases a mother's nutritional needs:

Vomiting past the third month of pregnancy.

Pregnancies spaced less than a year apart.

Previous pregnancy with low birthweight, neurologically handicapped, or stillborn child as the outcome.

A history of two or more miscarriages.

A history of toxemia.

Failure to gain ten pounds by the twentieth week of pregnancy.

Serious emotional problems.

Working full-time at a demanding job.

Breastfeeding an older baby during pregnancy.

Multiple pregnancy (twins or more).

As a corrective allowance, Mrs. Higgins and her staff counsel mothers to add twenty grams of protein and two hundred
calories to their basic daily pregnancy diets for each condition listed above (an individual mother
may be experiencing more than one of these stress conditions).

Multiple pregnancy is the only exception: each extra baby requires a nutritional supplement of thirty grams of protein
and five hundred calories per day. Higgins comments that this requirement can be met most economically by adding
one quart of whole milk a day to the expectant mother's diet (to be drunk, used in cream soups, custards, milkshakes, cream
pies and tarts, or as exchanges in yogurt, ice milk, and natural cheeses). Of course, there are many other ways to increase
the protein and calories during pregnancy by eating an additional four-ounce serving of meat, fish, shellfish, poultry, or
meat substitute as detailed on the diet list. A sample daily menu plan for a mother expecting twins would look something
like this:

Generally speaking, these conditions result in an increased appetite; however, women who are working, moving
their households, or under emotional stress sometimes fail to pay attention to their bodies' signals for more
food. Calling special attention to their extra needs by assigning specific goals for extra protein and calorie consumption
makes it much less likely that their nutritional needs will go unfulfilled.

Undernutrition means any protein deficit between what you're used to getting from your food and the minimum adequate pregnancy
requirement (eighty to a hundred grams per day). The Higgins nutrition intervention method uses a twenty-four hour diet recall,
a technique you can use on your own to see how close your regular diet has been coming to what you actually need. You will
need to write down everything you've eaten for the past twenty-four hours (pick a typical day for you), including all
snacks, all beverages, and all second helpings. Note what the food was, how much you ate, then consult the Protein-Calorie
Counter (see Appendix) to check the amount of protein contained in those portions of those foods. For each gram of protein
you lack, add that to your personal protein goal, plus an additional ten calories to free that protein for its most important
work in pregnancy: keeping you own tissues healthy and building those of your unborn baby. If you come up with a deficit
of ten grams of protein, then, you also need to add a hundred calories to your basic requirements.

The following is reprinted from Nine Months, Nine Lessons, by Gail Sforza Brewer, 1983 (p. 50).

Placenta

As Figure 8 shows, it is also the action of your uterus that separates your placenta and expels it in the third stage of labor.
This organ allows nutrients and oxygen to pass from your bloodstream into your baby's and also permits the removal of waste
products from the baby's body. The placenta originated in cells from the fertilized egg. Enzymes on the surface of the ovum
dissolved away a tiny portion of the surface of your uterine wall, opening a few arteries and veins in the process. With
each beat of your heart, from that moment until your placenta comes away from the wall of your uterus, those arteries spurt
jets of nutrient- and oxygen-rich blood against the surface of the placenta. This is the only blood supply to this most important
organ, and only what is present in your bloodstream can nourish it and your developing baby.

The placenta is firmly anchored to the wall of your uterus by threads of collagen throughout and by a seal around its margin.
Because of this, the blood that swirls up against the placenta stays in a "lake," continuously bathing the placental tissue.
This blood does return to your heart after spending some time in the "lake," via the open veins that now function like the
drain in you tub or shower stall: the pooled blood is pushed into the veins by the force of new blood coming into the "lake"
from the open arteries. Technically, this sort of blood supply is termed an a-v (arterio-venous) shunt, meaning that
the blood passes directly from arteries to veins without first passing through capillaries (the usual way things are done
in the body).

Since the supply of blood encourages and supports placental growth, and a larger placenta requires more blood to keep it functioning
optimally, ever-increasing amounts of blood are required as pregnancy advances to satisfy the needs of the placenta. If you
are carrying a single baby, your blood volume will expand approximately 60 percent (if you eat well enough) to service your
placenta. If you have twins (and therefore a double placenta or two separat placentas), your blood volume must expand by
100 percent or more to stay even with the demand. A falling blood volume or a blood volume that is below the needs of your
pregnancy is recognized as a major cause of premature labor, underweight babies, and high blood pressure during pregnancy.
When you recognize the importance of keeping your blood volume up and your placenta healthy (even though you can't see it
or feel it), you will have a strong inducement to stay on your excellent pregnancy diet every day.

[Iatrogenic = Induced inadvertently by a physician or surgeon or by medical treatment or by diagnostic procedures]

Frank Hytten tells us in his pregnancy physiology textbook of two pioneers in the field of iatrogenic starvation in human
pregnancy.(1) A certain Professor Brunninghausen of Wurzburg decided, for reasons unstated, that it was better for women
to eat less food during pregnancy; this was in 1803. A century later Prochownick is given credit in 1899 for introducing
the idea that caloric and fluid restrictions during human pregnancy could produce an infant who weighed less at birth.(2)
The intention of Prochownick was to minimize the cephalopelvic disproportion in a woman with a borderline contracted pelvis
and thus reduce the incidence of surgical intervention in such patients. As surgical techniques developed with the practices
of asepsis and improved anesthesia established, Western European obstetricians lost all fear of operative delivery. Prochownick's
valuable clinical observation that caloric and fluid restrictions do in fact lower the birth weight of the newborn human infant
was forgotten. Thus a very important clue to the mystery of "low birth weight for dates" newborns was buried.

Unfortunately, this still universal misconception became established as a dogma in clinical obstetrical teachings in Western
medical culture: the human fetus is a parasite, will grow according to its "genetic code" to a given weight and length before
birth, and that this growth and development are in no concrete, material sense influenced by the foods and fluids the pregnant
woman is taking in during the course of her gestation.(3,4) Scientific obstetrics still suffers today from what I term "nutritional
nonchalance" related to this false belief.

In 1972 officially in the United States the cause of eclampsia, the disease I term convulsive metabolic toxemia of late pregnancy
(MTLP), was "unknown."(5,6) [This official assertion continues into 2008] Since this dread disease remains a common cause
of maternal, fetal and newborn morbidity and mortality throughout the world, speculations about its etiology continue. It
has been long believed that the Nutrition of the pregnant woman during gestation does in fact influence her development
of MTLP. Women who develop MTLP are still accused of eating too many calories and too much salt (NaCl). That such
an idea remains popular in 1973 stems from the fact taht very few Western-trained OB/GYN surgeons have ever taken time or
interest to ask these poor women what foods and how much they have been eating and drinking during pregnancy.

When I began to work in the Tulane Service's prenatal clinics at Charity Hospital, New Orleans, Louisiana, as a third year
medical student, pregnant patients were being told to restrict their caloric intake and to restrict their dietary salt intake:
"So you won't have fits....so you and your baby won't die from toxemia." It is difficult for me to learn what is happening
there now since no members of the Tulane faculty will communicate with me, but unofficial sources informed me not long ago
that "...nothing has changed in this field since you were here over 20 years ago." I studied this problem for four years
in another city-county hospital in our deep south. Jackson Memorial Hospital, Miami, Florida, from 1958 to 1962.
A reliable communication from an established ostetrician in Miami in March, 1973 informed me that "...nothing has changed
in this field since you left here over ten years ago." The common practices of weight control and dietary salt restriction
seem eternal.

Since it is now clear that the sudden, rapid weight gain observed in patients with severe MTLP is a result of malnutrition
with a falling serum albumin concentration, hemoconcentration, a falling blood volume with increasing interstitial fluid,
we no longer need to blindly "control weight" with starvation type diets. However, fear of the unknown drives the most rational
and "scientific" people to irrational actions; millions of pregnant women in Western European medical culture still suffer
from iatrogenic starvation diets in the vague hope that caloric and salt restriction will in some way protect them and their
unborn from the "ancient enigma of obstetrics," eclampsia.

Iatrogenic starvation in human pregnancy has a long and ignoble history in the United States: its traditions run strong and
deep in one of our oldest and most respectable journals of obstetrics, the American Journal of Obstetrics and Gynecology.
In its second volume published in 1921 we find this account by Rucker:

"On August 2nd, two weeks after her first visit, her blood pressure was 120/80, the urine was free from albumin and sugar.
On August 17 her weight had increased 6 pounds and her legs were swollen up to her knees. She had no headache. Blood pressure
was 180/90. Urine was free from albumin and sugar. She was placed upon a bread and water diet." (emphasis added)

"A week later, August 24, in spite of her rigid diet, she had gained 8 3/4 pounds more. (emphasis added) Her blood
pressure was 205/110 and she was having pains in the back of her head and was seeing specks before her eyes. The urine showed
a trace of albumin. No casts were found."(7)

Subsequently this poor woman had 11 convulsions. It is now clear that a "bread and water diet" is not effective prophylaxis
for MTLP!

In the very first volume of The American Journal of Obstetrics and Gynecology published 53 years ago [as of1974], Ehrenfest
reviewed "Recent Literature on Eclampsia," and found that venesection was still in common use for this dread disease: "For
the purpose of reducing the blood pressure and of eliminating toxins...."

He reported another then widespread approach: "Diuretics should be accompanied by a total or partial restriction of salt.
No meat shall be allowed." (emphasis added) Ehrenfest also noted the beginning of a scientific rejection of blood-letting
in the management of eclampsia: "Cragin says: Eclampsia patients after convulsions resemble so closely patients in shock,
that venesection seems illogical. They seem to need all the blood they have and more too."(8)

Here was the obvious clinical recognition of the hypovolemic shock which so commonly causes maternal and fetal deaths in severe
metabolic toxemia of late pregnancy.(9) The illogical use of salt diuretics in this disease may be viewed now as a "modern"
form of blood-letting in which electrolytes and water of the blood are forced out of the patient's body via her kidneys, a
kind of cell-free venesection!

In April, 1969, I presented a paper to an international meeting on "toxemia of pregnancy" in Basel, Switzerland, by invitation
of Dr. E.T. Ripperman, Secretary of the Organization Gestose.(10) Here I learned these interesting facts:

Eclampsia has virtually disappeared from Switzerland; there had been no maternal death from this disease in Basel for
almost two decades.

Some Swiss OB/GYN professors were still teaching that the pregnant woman must avoid red meat as prophylaxis against
eclampsia; for the Swiss this prescription seems to be working.

The incidence of low birth weight babies born in the University Hospital, Basel, in the year 1967, from some 3,000 deliveries
was 3.0%.

It soon became apparent here from my discussions with many European OB/GYN authorities that the general nutritional status
of the peoples of Central Europe was exceptionally good, and that this adequate nutrition was the basic cause for the elimination
of severe MTLP and for the relatively low incidence of low birth weight infants.

My own paper presented in Basel was received with the utmost skepticism: the European obstetricians almost to the man responded:
"Surely there is no severe malnutrition in rich America." Surely? The incidence of low birth weight in our nation has risen
from 7.0% in 1950 to 10.0% now [1974] with much higher figures for all our poverty areas; MTLP continues to cause maternal-fetal
and newborn morbidity and mortality. Iatrogenic starvation during human pregnancy is still widely practiced throughout our
nation today because none of our medical or "public health" institutions have taken concrete actions to stop it.

A review of the unbound issues of The American Journal of Obstetrics and Gynecology reveals that for most of the 1950's and
1960's amphetamines and other "diet pills" were widely advertised for "weight control" in human pregnancy. Salt diuretics,
long recognized to be lethal to the severely toxemic patient and to her fetus, were promoted by this journal form 1958 to
1972. Professor Leon Chesley finally recognized their harmful effects on the maternal plasma volume.(11) The advertisements
for these water pills were then stopped but not their widespread use.

Today in 1973 the problems of rising prices for essential foods like lean meats, chicken, eggs, vegetables and fruits, and
the continuing poverty and economic depression in many areas of our nation can not be solved by the nation's physicians.
However, do not humane physicians today have a special and moral responsibility to stop the blind errors of iatrogenic
starvation in human pregnancy? Do not obstetricians, especially, in charge of human antenatal care in public clinics
and private offices, have a responsibility to their pregnant patients to give them scientific nutrition information? The
protective effects of applied, scientific nutrition in human antenatal care have recently been dramatically documented by
Mrs. Agnes Higgins of the Montreal Diet Dispensary.(12) The rationale for blind weight control to any "magic number" of pounds
in human pregnancy has been completely destroyed.(13) What then must the obstetricians of our nation do? What actions must
they take to insure maternal-fetal and newborn health for each woman who wants to produce a normal, full term child and remain
in good health herself?

Recognize the complications of human pregnancy caused by malnutrition.(14)

Teach each pregnant woman as a routine part of modern, scientific prenatal care, the basic principles of applied scientific
nutrition.

Insure that she actually eats an adequate, balanced diet all through gestation.

Encourage her to salt her food "to taste." (with rare exception)

Stop "weight control" to any number of pounds. (when nutrition is adequate and balanced, the weight gain takes
care of itself with an average gain in healthy pregnancy of about 35 pounds)

Protect each pregnant woman and her unborn from all harmful drugs, especially salt diuretics and appetite depressants.

On the postpartum wards educate all pregnant patients who have suffered nutritional complications during pregnancy--so that
those complications will not recur in subsequent pregnancies.(15)

Stop iatrogenic starvation in human pregnancy.

These measures will begin to open a new era in preventive obstetrics in our nation and dramatically reduce the numbers of
low birth weight and brain-damaged and mentally retarded children now being born.

There is more information related to IUGR babies following these references

1) Print out the weekly record on this page and post it on your refrigerator and make sure that there is a check mark
in every box by the end of the day. That is the minimum intake needed. The next suggestions are for adding on top of that
baseline.

2) Eat something with protein in it every hour of the day that you are awake, setting an egg timer or your watch or
cell phone to go off every hour during the day, so that you do not skip one of these snacks. Some suggestions for these snacks
include a handful of nuts, or cheese cubes, or an egg, or a cup of yogurt, or some trail mix, or a glass of milk. Keep a
protein snack by your bedside for eating/drinking when you wake up during the night (suggestions: nut butter sandwich, cup
of milk, cup of kifer). Try to increase the daily intake to 150-200 grams of protein (singleton pregnancy).

Also, for three days, eat 17 eggs a day and 2 quarts of milk a day.

3) Increase the number of nutritious calories eaten each day to 3,000-4,000 calories (singleton pregnancy). Avoid
using junk food or refined carbohydrates to help with this increase.

One way to help your needed increase of calories is to start drinking a form of milk with a higher fat content--like switching
from skim to 2%, or from 2% to whole, or whatever increase you can tolerate (like a mixture of 1/2 2% milk and 1/2 whole milk).

4) Make sure that you add salt to every serving of food that you eat. The Brewer Diet is actually a triad of salt
PLUS calories PLUS protein, so an effort to expand the blood volume needs to include an increase of all three factors.

6) Evaluate your lifestyle and see if you can cut down on some kinds of physical activity, or live or work in a cooler
environment, or cut out some stress-producing factors. All of these factors can add to your losses of salt, fluids, and calories.
See this page for more ideas about this process (scroll to halfway down the page for the beginning of the suggestions)....

7) Make sure that you avoid all herbs which have diuretic properties. Check the list of ingredients of all supplements
and herbal teas that you use, to make sure that they do not contain any of the herbs listed on the page in the following link.
My only exception to that would be Floradix, unless the use of all of the above suggestions has no effect, in which case
I would suggest eliminating Floradix as well IF it includes one of the herbs listed here....

10) If you have protein in your urine, make sure that the protein is not from a discharge from the vagina, or from
a bladder or kidney infection. Sometimes at the end of pregnancy, as everything ripens, there is more discharge from the
vagina, or if there's a yeast infection, some protein from the vagina can show up in the urine. To decrease the chances of
protein from the vagina showing up in the urine, you can ask your midwife to help you do a "clean catch" of your urine sample.
You can also ask your midwife to send your urine to a lab to be tested for other factors which may indicate a bladder or
kidney infection.

11) Ask your midwife to test your hematocrit and hemoglobin. If it is stable or rising, then there's a good possibility
that you are in an early PE process. For more information about that, and what to do for that, you can see the following
link....

The following is from a chapter reprinted by permission from 21st Century Obstetrics Now! (David Stewart, PhD,
and Lee Stewart, CCE, Editors), National Association of Parents & Professionals for Safe Alternatives
in Childbirth, 1977. (p. 387)